Schizophrenia Booklet 6: Psychological therapies Flashcards
What are the three types of psychological treatments on the spec?
-CBT
-Family Therapy
-Token Economies
What is CBT?
-Main psychological treatment for people with sz
-Can be completed on an individual basis or in a group
-Ranges from 5 session to 20
What is CBT based on?
The idea that the development of SZ is linked to dysfunctional thoughts, so CBT works by identifying and changing maladaptive and irrational thoughts in people
What symptoms does cbt target
Positive symptoms
What is one form of CBT for SZ?
Personal Therapy
What is Personal Therapy?
A detailed evaluation of the problems and triggers of irrational thoughts, it involves the therapist and client working together to create coping techniques
What are some examples of coping techniques in Personal Therapy?
-Distractions from intrusive thoughts
-Challenging the meaning of intrusive thoughts
-Increasing/decreasing social activity to distract from low moods
What are the evaluations of CBT?
😀Effective (Tarrier)
😀More appropriate than drug therapy (side effects)
😥Less appropriate (more expensive)
😥Less appropriate (severe sz symptoms)
What did Tarrier find about CBT?
Reviewed 20 controlled trials of CBT using 739 patients, found persistent evidence of reduced symptoms, especially positive symptoms, lower relapse rates and speedier recovery time in the short-term
What is family therapy?
-A form of psychotherapy based on the idea that family dysfunction causes sz
-So altering relationship and communication patterns in families help sz patients recover
-In particular, lowering expressed emotion
What makes family therapy different to other therapies?
Involves the whole family instead of just the individual
What are some examples of what family therapy would do?
-Improve positive and decrease negative communication
-Increase tolerance and decrease criticism levels between family
-Decrease guilt and responsibility for causing illness among family
-Form therapeutic alliance with all family members
How long does family therapy happen for?
Around 9-12 months
What are the evaluations of family therapy?
😀/😥Effective (Leff)
😀Appropriate (severe symptoms)
😀Appropriate (cheaper, Schizophrenia Commission)
😥Not appropriate all families
What did Leff find to support and contradict the effectiveness of family therapy
-Compared family therapy with routine outpatient care for schizophrenics with families with high EE. Found within the first 9 months of treatment 50% of those who experienced routine care relapsed, compared with only 8% receiving family therapy
-However after 2 years of treatment 75% of patients had relapsed and 50% who experienced family therapy
What did the Schizophrenia Commission say about the costs?
Estimated that family therapy is cheaper than standard care by about £1000 a patient over three years
What are token economies?
A behaviourist therapeutic approach to the management of schizophrenia, where tokens are awarded when patients show a desired behaviour
Which symptoms do token economies particularly target?
Negative symptoms such as avolition and lack of motivation
Where are token economies mainly used?
Long term hospitalised patients
What do the tokens do?
They can be exchanged for goods and privileges which give direct pleasure
What are the evaluations of token economies?
😀Evidence of effectiveness (Ayllon and Azrin)
😥Only work in institutions
😀Can be personalised
😥More effective for those with mild symptoms, than severe
What was found in Ayllon and Azrin?
Found token economies were successful through rewarding female schizophrenic patients that were hospitalised, they were rewarded for behaviours like making a bed and brushing hair. They found that average number of chores completed rose from 5 to 42
What comparison points can be considered between treatments?
-Which approach is it?
-Are they appropriate for severe sz?
-Positive and/or negative symptoms
-How effective long/short term?
-Side effects?
-Do they require a therapist?
-Ethical?
-Work for all patients?
